Proposals on the long-term funding of adult social care in England are unlikely to be delivered before 2028 at the earliest, the government has confirmed.
Health and Social Care Secretary Wes Streeting is promising “to finally grasp the nettle on social care reform”, with an independent commission due to begin work in April.
But the commission, chaired by Baroness Louise Casey, is not due to publish its final report until 2028.
Councils and care providers say that is too long to wait for the reform of vital services already on their knees.
The commission comes alongside immediate government plans to get care workers to do more health checks, and a funding boost for services to help elderly and disabled people remain in their homes.
It will be split into two phases, the first of which will report by mid-2026 and identify critical issues and recommend medium-term improvements.
But phase two, which will look at how to organise care services and fund them for the future, will not report until 2028 – a year before when the next election must be held.
Social care means help for older or disabled people with day-to-day tasks such as washing, dressing, medication and eating.
Only those with the most complex health needs get social care provided free by the NHS, so most care is paid for by councils.
In England, only people with high needs and savings or assets of less than £23,250 are eligible for that help, leaving a growing number of people to fund themselves.
Some face paying hundreds of thousands of pounds for their care and may be forced to sell their own home as a result.
The government’s ultimate aim is “a new National Care Service, able to meet the needs of older and disabled people into the 21st Century”, said Streeting.
He said he had invited opposition parties to take part in the commission “to build a cross-party consensus to ensure the National Care Service survives governments of different shades, just as our NHS has for the past 76 years”.
Baroness Casey – who has led several high-profile reviews, including into homelessness, the Rotherham child exploitation scandal and the Metropolitan Police – said she was pleased “to lead this vital work”. The commission will report to the prime minister.
She is viewed in government as being straight-talking, with good cross-party links, and as someone who gets things done.
Even so, drawing up a plan for a National Care Service that meets the needs of an ageing population and is affordable is perhaps her biggest challenge yet.
There is agreement the care system has been in crisis for years, struggling with growing demand, under-funding and staff shortages.
The problem has been getting political agreement on how overdue reform will be funded.
In 2010, Labour plans to fund social care were labelled a “death tax”‘ in that year’s election, and Conservative plans were called a “dementia tax” in the 2017 election.
There have also been numerous commissions, reviews and inquiries over the past 25 years that have failed to bring change.
The 2011 Dilnot Commission plan for a cap on individual care costs came closest, making it into legislation, but was not implemented.
It was finally scrapped by the new Labour government last summer because it said the last Conservative administration had not set aside the money to fund the reform.
However, providing enough support for people in their own homes, care homes and supported living remains a pressing issue.
The care systems in Scotland, Wales and Northern Ireland are slightly more generous, but all are facing the pressures of growing demand and squeezed finances.
“Our ageing society, with costs of care set to double in the next 20 years, demands longer-term action,” said Streeting.
The government had promised a National Care Service in its manifesto, although provided little detail.
Writing in the Guardian on Friday, Streeting acknowledged Labour “took a lot of flak” for not providing much detail, but added: “I was honest about the reason why – general election campaigns are where plans for social care go to die.”
The independent commission will work with users of care services, their families, staff, politicians and the public to recommend how best to build a care service to meet current and future needs.
“Millions of older people, disabled people, their families and carers rely upon an effective adult social care system to live their lives to the full with independence and dignity,” said Baroness Casey.
“An independent commission is an opportunity to start a national conversation, find the solutions and build consensus on a long-term plan to fix the system.”
The King’s Fund independent health think-tank urged the government to “accelerate the timing” of the commission.
“The current timetable to report by 2028 is far too long to wait for people who need social care, and their families,” said its chief executive, Sarah Woolnough.
Melanie Williams, president of the Association of Directors of Adult Social Services, agreed the “timescales are too long”.
She believes many options on how to reform adult social care are already known and worries that “continuing to tread water until a commission concludes will be at the detriment of people’s health and well-being”.
About 835,000 people received publicly funded care in 2022, according to the King’s Fund. The charity Age UK estimates there are about two million people in England who have unmet care needs – and according to workforce organisation Skills for Care, while 1.59 million people work in adult social care in England, there are currently 131,000 vacancies.
Helen Walker, the head of Carers UK, which represents millions of unpaid people who provide care to family members, said families were “under intense pressure and providing more care than ever before”.
Amanda Pritchard, NHS England chief executive, said: “We hope this vital action plan and commitment to create a National Care Service will both help better support people and ease pressure on hospital wards.”
The government also confirmed an extra £86m would be spent before the end of the financial year in April to help thousands more elderly and disabled people to remain in their homes.
The money is on top of a similar sum announced in the Budget for the next financial year.
Overall, it should allow 7,800 disabled and elderly people to make vital improvements to their homes which should increase their independence and reduce hospitalisations, says the government.
Other changes include:
- better career pathways for care workers
- better use of technology and new national standards to support elderly people to live at home for longer
- up-skilling care workers to deliver basic checks such as blood pressure monitoring
- a new digital platform to share medical information between NHS and care staff.
